Public Entity Application Port/Transportation/Airport ...



|[pic] |Euclid Public Sector |

| |234 Spring Lake Drive |

| |Itasca, Illinois 60143 |

| |Phone (630) 238-1900 Website: |

| | Mailbox: |

| |mail@ |

Public Entity Application

Illinois / Indiana Township Supplemental Questionnaire

(Attaches to EPS-GEN-APP Applicant Information Section)

Legal Name of Public Entity:       Effective Date:      

A. BASIC FUNCTIONS

Which of the following basic function do you perform?

General assistance for the indigent

Assessment of real property for the basis of taxation

Maintenance of all roads and bridges outside the federal, state and other jurisdictions

(that have been accepted into the township road system)

Fire protection

B. AUXILIARY FUNCTIONS

Which of the following auxiliary function do you perform?

Senior Citizen programs

Youth Programs

Assistance to the disabled

Parks and Recreational facilities

Health Services

Cemetery maintenance

Land use

Other (please describe)

     

The undersigned declares that to the best of his/her knowledge, the information set forth in this application is true and complete.

                 

 Signature of Authorized Public Official Title Date

Refer to EPS-GEN-APP application form for the state fraud warnings.

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